| NPI | 1083796965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: MI 4301404930) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301404930) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-01-06 |